aspan standards for phase 2 discharge

The evidence model below guided the search, providing inclusion and exclusion information regarding patients, procedures, practice settings, providers, clinical interventions, and outcomes. Strongly Agree: Median score of 5 (at least 50% of the responses are 5), Agree: Median score of 4 (at least 50% of the responses are 4 or 4 and 5), Equivocal: Median score of 3 (at least 50% of the responses are 3, or no other response category or combination of similar categories contain at least 50% of the responses), Disagree: Median score of 2 (at least 50% of responses are 2 or 1 and 2), Strongly Disagree: Median score of 1 (at least 50% of responses are 1). The 2008 standards of the American Society of PeriAnesthesia Nurses (ASPAN) 6 lists voiding as part of discharge criteria for phase II recovery but recognizes that there are variations in voiding requirements depending on the policies of individual institutions. Level of muscular strength and consciousness 4. THE PATIENT SHALL BE CONTINUALLY EVALUATED AND TREATED DURING TRANSPORT WITH MONITORING AND SUPPORT APPROPRIATE TO THE PATIENTS CONDITION. Refer to table 4 for examples of emergency support equipment and pharmaceuticals. Analgesics administered with sedatives include opioids such as fentanyl, alfentanil, remifentanil, meperidine, morphine, and nalbuphine. Surgery Phase, PACU Phase I, Phase II and Extended Care PR 4 Recommended Competencies for the Perianesthesia Nurse PR 5 Competencies of Perianesthesia . Patients receiving conscious sedation can either be brought to the PACU or delivered to stage 2 recovery (see Phases of Postanesthetic Recovery in this chapter) at the discretion of the anesthesiologist. When moderate procedural sedation with sedative/analgesic medications intended for general anesthesia by any route is intended, provide care consistent with that required for general anesthesia, Assure that practitioners administering sedative/analgesic medications intended for general anesthesia are able to reliably identify and rescue patients from unintended deep sedation or general anesthesia, For patients receiving intravenous sedative/analgesic medications intended for general anesthesia, maintain vascular access throughout the procedure and until the patient is no longer at risk for cardiorespiratory depression, In patients who have received sedative/analgesic medications intended for general anesthesia by nonintravenous routes or whose intravenous line has become dislodged or blocked, determine the advisability of reestablishing intravenous access on a case-by-case basis, Administer intravenous sedative/analgesic medications intended for general anesthesia in small, incremental doses or by infusion, titrating to the desired endpoints, When drugs intended for general anesthesia are administered by nonintravenous routes (e.g., oral, rectal, intramuscular, transmucosal), allow sufficient time for absorption and peak effect of the previous dose to occur before supplementation is considered, One placebo-controlled RCT reports that naloxone effectively reverses the effects of meperidine as measured by increasing alertness scores and respiratory rate (category A3-B evidence).164 Reversal of respiratory depression, apnea, and oxygen desaturation after naloxone administration in other practice settings is also reported by observational studies (category B3-B evidence)165,166 and case reports (category B4-B evidence).167170, Meta-analysis of double-blind placebo-controlled RCTs indicates that flumazenil effectively antagonizes the effects of sedation within 15min for patients who have been administered benzodiazepines (category A1-B evidence).171178 Placebo-controlled RCTs also indicate that flumazenil administration is associated with shorter recovery times for benzodiazepine sedation (category A2-B evidence).176,179181 Meta-analysis of placebo-controlled RCTs indicate that flumazenil effectively antagonizes the effects of benzodiazepines when combined with opioids (category A1-B evidence).182186. Reversing intravenous sedation with flumazenil. All main OR patients (with the exception of ICU patients) go to phase 1 (main recovery room) until they meet the requirements of stability. Reflex withdrawal from a painful stimulus is NOT considered a purposeful response. Another patient is a 6-year- old child whose parents have left to eat. . What Age Is Considered Elderly? ASPAN recommends assessing and documenting vital signs at least every 15 minutes during the first hour and then every 30 minutes until discharge from Phase I PACU care.5 The patient is then transitioned to Phase II, the inpatient setting, or the intensive care unit (ICU) for continued care.6 Awareness and collaboration Staffing should reflect One respondent (1.92%) estimated a decrease in the amount of time they would spend on a typical case. A comparison of midazolam with and without nalbuphine for intravenous sedation. The three most common cases were: (1) respiratory/airway issues (43%); (2) cardiovascular problems (24%); and (3) drug errors (11%). 2. The . endstream endobj 11 0 obj <> endobj 12 0 obj <> endobj 13 0 obj <>stream See table 3 and/or refer to: American Society of Anesthesiologists: Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures: An updated report. Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children. These values represent moderate to high levels of agreement. The purposes of these guidelines are to allow clinicians to optimize the benefits of moderate procedural sedation regardless of site of service; to guide practitioners in appropriate patient selection; to decrease the risk of adverse patient outcomes (e.g., apnea, airway obstruction, respiratory arrest, cardiac arrest, death); to encourage sedation education, training, and research; and to offer evidence-based data to promote cross-specialty consistency for moderate sedation practice. Notably, all ambulatory surgery patients. Discharge medications; instructions for pain management A complete bibliography used to develop these guidelines, arranged alphabetically by author, is available as Supplemental Digital Content 1, http://links.lww.com/ALN/B594. Body mass index (BMI) predicts the need for airway intervention and sedation related complications in anesthesiologist-directed propofol sedation for routine EGD and colonoscopy. Perioperative Services Registered Nurse. e. Discharge readiness and ready to transfer should occur concurrently. Updated by the American Society of Anesthesiologists Committee on Standards and Practice Parameters: Jeffrey L. Apfelbaum, M.D. 3. The rate of return was 34.6% (n = 55 of 159). Consultants were drawn from the following specialties where moderate procedural sedation/analgesia are commonly administered: anesthesiology, cardiology, dentistry, emergency medicine, gastroenterology, oral and maxillofacial surgery, pediatrics, radiology, and surgery. Titration of drug to effect is an important concept; one must know whether the previous dose has taken full effect before administering additional drug. A comparison of the effects of midazolam/fentanyl and midazolam/tramadol for conscious intravenous sedation during third molar extraction. Cherry Hill, N.J.: American . Standard V: Physician is responsible for the discharge of the patient from the post anesthesia care unit. However, the distribution of complications differed a bit. For these guidelines, sedatives intended for general anesthesia include propofol, ketamine and etomidate. Sedatives not intended for general anesthesia (e.g., benzodiazepines, nitrous oxide, chloral hydrate, barbiturates, and antihistamines) are included either as comparison groups or in combination with sedatives intended for general anesthesia. D. Requirements for determining discharge readiness. Because fast-tracking in the ambulatory setting implies taking a patient from the OR directly to the Phase II discharge Download PDF. Effect of a single dose of propofol and lack of dextrose administration in a child with mitochondrial disease: A case report. 2. A comparative evaluation of intranasal dexmedetomidine, midazolam and ketamine for their sedative and analgesic properties: A triple blind randomized study. (ASPAN 2010 - 12) IHOP Policy 09.01.29 3 . Anesthesiology 2017; 126:37693. American Society of Anesthesiologists: Continuum of depth of sedation: Definition of general anesthesia and levels of sedation/analgesia. Proceed based on the facility policy for unaccompanied discharge, including consideration for Phase 2 recovery time for increased observation. For ambulatory surgery patients, this often takes 1 to 3 days. Describe commonly used post anesthesia care unit (PACU) discharge criteria. /.uD6 n{M =-uSn}oq2~;.S;uX#eGFwhPz}4dO:~?#~$y`~`.PK >Bj The facility policy may require a specific time period after discharge criteria are met that the patient must remain in the facility. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 In my facility phase 1 is from adm to pacu until back to floor for inpts. Buy Membership for Anesthesiology Category to continue reading. Fixed and random-effects odds ratios are reported for dichotomous outcomes, and raw and standardized mean differences are reported for findings with continuous data. The literature is insufficient to determine whether monitoring patients level of consciousness improves patient outcomes or decreases risks. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Hope this helps. d. Physician evaluation is used in place of discharge criteria or discharge score. Patient safety processes include quality improvement and preparation for rare events. Available at: Joint Commission: Speak up anesthesia infographic, American Academy of Pediatrics; American Academy of Pediatric Dentistry. (Committee Chair and Task Force Co-Chair), Chicago, Illinois; Jeffrey B. The standards are, at times, vague (e.g., standard #1 below) and can certainly be. continue the use of antiembolic stockings if ordered. All of the medications given intraoperatively to enable tolerance of airway manipulation and surgical stimulation can undermine normal respiratory function postoperatively. Conversely, inadequate sedation or analgesia can result in undue patient discomfort or patient injury, lack of cooperation, or adverse physiological or psychological responses to stress. The PACU team cares for patients in all age ranges and all levels of acuity including ambulatory, inpatient, and critical care. Home; Products. Meet American Society of PeriAnesthesia Nurses (ASPAN) Standards of Perianesthesia Nursing Practice 2008-2010. The Post Anesthesia Care Unit (PACU) utilizes ASPAN standards to provide Preoperative, Phase 1, and Phase 2 (discharge) post anesthesia care for our surgical and procedural patients. 3 Approved by the American Association of Oral and Maxillofacial Surgeons on September 23, 2017; the American College of Radiology on October 5, 2017; the American Dental Association on September 21, 2017; the American Society of Dentist Anesthesiologists on September 15, 2017; and the Society of Interventional Radiology on September 15, 2017. 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